Healthcare Provider Details

I. General information

NPI: 1629655394
Provider Name (Legal Business Name): AVERY BRYAN DAILY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 PRESCOTT RD STE 201
ALEXANDRIA LA
71301-3983
US

IV. Provider business mailing address

1601 EMBERLY OAKS DR
ALEXANDRIA LA
71301-2785
US

V. Phone/Fax

Practice location:
  • Phone: 318-442-6767
  • Fax: 318-441-1359
Mailing address:
  • Phone: 318-376-6488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD.352406
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: